Healthcare Provider Details

I. General information

NPI: 1922086651
Provider Name (Legal Business Name): GAYANE ANDRANIK MATULIAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 GRIFFITH PARK BLVD
LOS ANGELES CA
90039-2520
US

IV. Provider business mailing address

2650 GRIFFITH PARK BLVD
LOS ANGELES CA
90039-2520
US

V. Phone/Fax

Practice location:
  • Phone: 323-660-5522
  • Fax: 818-551-9976
Mailing address:
  • Phone: 323-660-5522
  • Fax: 818-551-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number44214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: